Liver Injury Correlates With Increased Mortality in Patients With COVID-19

covid19 virus structure
Investigators assessed the outcomes of patients with coronavirus disease 2019 and liver injury.

Patients with coronavirus disease 2019 (COVID-19) who presented with liver injury were found to have a significantly increased risk of mortality, mechanical ventilation, intensive care unit (ICU) admission, and 30-day hospital re-admission vs patients with mild elevation in liver function tests (LFTs) and normal LFTs, according to data presented during the 2020 American College of Gastroenterology (ACG) Annual Scientific Meeting.

Specifically, patients with liver injury had an increased risk of mortality compared with patients with normal LFTs both at presentation and throughout hospitalization (control group), with a relative risk (RR) of 4.26 (95% CI, 3.12-5.81; P< .0001). The RR for ICU admission, intubation, and 30-day hospital re-admission in patients with liver injury vs patients with normal LFTs was 5.52 (95% CI, 4.07-7.49; P <.0001), 11.01 (95% CI, 6.97-17.34; P <.0001), and 1.81 (95% CI, 1.17-2.80; P <.0076), respectively.

Liver injury appears to be prevalent in patients with COVID-19; however, there is a limited number of large-scale studies available on the risk factors, morbidity, and mortality associated with liver injury in this patient population. The study authors aimed to determine the risk factors and outcomes of patients hospitalized with COVID-19 and liver injury by performing a retrospective single-center study at a large, tertiary-care hospital. The study included all index admissions of adults with confirmed COVID-19 diagnoses between March 1, 2020 and April 30, 2020.

There were 1935 adults in the study population, 507 (26.2%) of whom had normal LFTs. The remaining 1030 patients (53.2%) and 397 patients (20.5%) had mildly elevated LFTs or liver injury, respectively.

Mild elevation in LFTs was defined as peak levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and total bilirubin (TB) above the upper limit of normal (ULN) but lower than the threshold for liver injury. Liver injury was defined as peak ALT/AST 3 times ULN and/or peak ALP/TB 2 times ULN. ULN threshold values of ALT 52, AST 35, TB 1.2, and ALP 140 were used to facilitate the analysis.

Regarding patient characteristics, men were more commonly found in the group of patients with mild elevation in LFTs (P =.0004) and the subset of patients with liver injury (P <.0001) compared with the control group (P <.0001). Patients with mild elevation in LFTs were also older than patients with liver injury and patients in the control group (P =.0005).

Black patients were found to be more likely to develop liver injury (P =.0318). There was no difference in comorbidities between all groups. Among patients with liver injury, 241 (61%) had a hepatocellular pattern, 20 (5%) had a cholestatic pattern, and 135 (34%) had a mixed pattern.

The study authors concluded that the findings from this study are “important to appropriately manage COVID-19 patients.”


Siddiqui M, Suresh S, Ghanimeh MA, et al. Liver injury is associated with increased morbidity and mortality in COVID-19 patients. Presented at: American College of Gastroenterology Annual Scientific Meeting; October 26-28, 2020. Abstract S0979.